A blog for those who want to write realistic medical scenes and need advice.

Wednesday, February 12, 2014

Choking on Valentine's Chocolates--How to Write It

My character receives a box of chocolates for Valentine’s Day. When he eats
the first one, he chokes. His roommate thinks the chocolates are poisoned, but
the guy is only choking. How can I write the choking?

Choking happens when something blocks the airway—the
trachea. Food and air share the same route until dividing into the esophagus
(passage to the stomach) and

trachea (airway). A specialized flap called the
epiglottis covers and protects the airway during swallowing. Anything that
makes it past the epiglottis—food or object—can get stuck and cut off the air
supply. Drugs, alcohol, and some medical conditions increase the risk of
choking.

The victim usually grabs
their throat—universal choking sign—and becomes agitated.

The blockage can be partial
or complete.

With partial
obstruction, there may be gagging, wheezing, coughing, or other sounds. It
requires air movement to make sound.

With complete
obstruction, the victim can’t talk or make noise. Because of lack of oxygen, he
may begin to turn blue (cyanosis) from low blood oxygen.

Treatment on the Scene

Airway obstruction is a
medical emergency. Have a bystander call 911. Even if the victim is fine by the
time the paramedics get there, it’s vital to call immediately. If there is no
one else around, do the following before
calling 911.

The Five and Five method:

--Five back blows: using
the heel of your hand, strike the victim between the shoulder blades five
times. This may dislodge the obstructing object.

--Five abdominal thrusts
(Heimlich maneuver): Stand behind victim; wrap your arms around their waist and
tip them forward a bit. With one hand, make a fist and place it just above the
belly button. Grip the fist with your other hand. Press hard with a quick
upward motion—a thrust—the way you’d try to pick someone up. This generates an
artificial “cough,” or rush of air from the lungs to “blow loose” the blockage.

If the victim is obese
or pregnant, place the fist in the middle of the chest.

NOTE: If YOU are the victim, make the fist and
position the same way, and lean on a hard surface. Forcibly push your fist
in/up.

Repeat the five and five
until effective or help arrives.

If the victim loses
consciousness (passes out) position them on their back. Position hands just
beneath the ribcage and gently thrust upward.

If there is no response
and the victim has no pulse, Begin CPR until help arrives. Do NOT try to drive
the victim to the ED yourself.

Treatment in the ED

In the Emergency Department,
a needle in the trachea can be used to restore air flow until the obstruction
is relieved and/ or a larger more permanent airway can be placed in the
trachea. A small cut is made in the skin slightly below the Adam’s apple, and a
needle is inserted to make a temporary detour for air.

I don’t recommend a
layman try this needle maneuver in real life, but in fiction it’s potentially
useable.

In the field, this might
be done without the cut. There are blood vessels in this area, so I don’t
recommend using a hunting knife to make a big hole—no matter what you’ve seen
in the movies. A small pocket knife would be believable.

Yes, you could use any
hollow object instead of a needle. A heavy duty drinking straw, a pen casing, etc.
would work. Just be sure it doesn’t disappear down the hole and make things worse.

No matter what, call
911 beforehand.

Hope this helps!

Comments? Questions?~*~
Kelly has worked in the medical field for over twenty years, mainly at
large medical centers. With experience in a variety of settings, chances are
Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous. Find Kelly’s fiction at www.kellywhitley.com